Heart and Lungs Flashcards
Examiner auscultates the patient’s second intercostal space on the left what valve would he be listening to?
Pulmonic Valve
Pt. given IV NTG, tPA and lidocaine in the ER. What 3 things will the TpA and Lidocaine do?
breaking of clot, systemic vasodilation, fixing arrhythmia
What determines the oxygen demand on the heart?
Rate pressure product (HRxSBP)
The carotid artery pulse refers to what heart sound?
S1-Sytole
What diagnostic test should be administered for female patient experiencing indigestion and chest pain with sitting and ambulation. A. Exercise Stress Test B. Holter Monitor C. Echo D. Chest X Ray
Exercise Stress Test
Which diagnostic test would be best and least invasive for valvular dysfunction?
Echo
What criteria do health care professionals use to diagnose a patient with MI?
- Symptoms
- Increase in Cardiac Enzymes
- Changes in EcG Leads
Leads V1-6 corresponds with what portion of the heart?
Left Main Coronary Artery and it’s anterior portion.
High cholesterol, High blood glucose and High triglyceride levels point to?
Endocrine condition (diabetes)
Patient has just had CABG and has been on bed rest for 5 days what do you except for his HR and SpO2?
HR increase
SpO2 decreased
Leads II, III, aVF supply which part of the heart?
Inferior portion (RCA)
In a deconditioned patient what would you except to happen to HR and SV?
HR Increase
SV Decreased
Which is the Most Correct the LCA supplies _______and the RCA supplies ______?
the LCA supplies the (Anterior and Lateral portions of the heart) and the RCA supplies (RA, both ventricles, back of septum)
Which of the following is not a risk factor for CAD? A. Smoking B. Obesity C. Stress D. Diabetes
C. Stress (it is how the patient handles their stress)
You enter a patient’s room and they have an IABP, what does an IABP do? Can you mobilize a patient with an IABP?
Increases oxygen perfusion to the myocardium ,by allowing the pressure to stay up in the aorta. The IABP inflates during diastole increasing blood flow back in the coronary arteries. ONLY mobilize if the IABP is placed in UEs not LEs.
Mitral Valve stenosis results in
pulmonary edema
What is the difference between ischemia and MI?
ischemia is partial block with no symptoms at rest, MI total blockage with symptoms at rest
Mr. D has a Borg level of 11, HR increases by 14 bpm while you are ambulating him. He appears to have no increase in symptoms and no increase in SOB, would you continue to exercise this patient?
Stay at the same level of intensity. Walking is approx.2 mets.
How is smoking a risk factor for CAD?
release of carbon monoxide releasing factor in which damages the endothelial layer of the arteries
A female patient had a slight drop in BP and slight increase in HR going from sit to stand. Then an even bigger drop in BP and even more of an increase in HR when ambulating. How would you define this reaction?
Normal sit to stand reaction, exertional hypotension.
Which is not a benefit of a heart failure program?
Decreased risk of sudden death
Heart transplant medications:azathioprine, cyclosporine and predisone which is not true about these meds?
Meds will INCREASE RHR.
Can you exercise a patient with a PA catheter?
Depends on the hemodynamic stability of the patient
According to findings, which of the following shows that the patient is not ready for mobility? A. INR >2 B. SpO2 90% C. Glucose 240 D. SBP 150 mmHG
Blood Glucose levels of 240
Which patient is least likely to be safe to initiate gait training?
Patient undergoing hemodialysis
What is the indication for use of an AICD?
Used with patients with life threatening arrthymias. Such as v Tach and V fib
A diabetes patient presents with muscles aches and pain in both legs (bilateral leg pain). What is the least important question to ask during your subjective?
Are you taking blood thinners (as you think it can be DVT) DVT is usually UNILATERAL!
Which is not an indication of an AICD?
controlled atrial fib
What are the two clinical signs and symptoms of heart transplant rejection?
Elevated temperature and decreased exercise tolerance
What is the normal pulmonary response to exercise?
rate and depth of breathing are both increased.
Know how to determine HR and ECGs from a strip.
MC:
Controlled vs. Uncontrolled atrial fib.
PVCs
What would you do if you noted coupled PVCs on ECG on a 6 sec strip while exercising a patient?
Stop exericse and call MD
What would you do if your patient had more than 6 PVCs per minute?
exercise should be stopped
Which of the following is not a restrictive lung disease? A. Asthma B. Pnemothorax C.Scoliosis D. Pregnancy -
-Ans. was asthma (but he gave credit for preg)
Restrictive lung diseases:
Obestity, pregnancy, Anklosing spondylitis, SCI, ALS, Pulmonary Edema, prenetrating injuries (Pnemo).
Have trouble getting air In. Pulmonary Fiborsis
Obstructive lung disease:
-COPD (chronic bronchitis, emphysema), Cystic Fibrosis
Which of the following is not an affect of inactivity?
Decreased production of osteoclasts
What would you do if you you palpate skipped beats in your patient?
You would consider them benign unless there are greater than 6 in a minute
46 year old male patient has a max HR of 156. What formula would you use to calculate HR to exercise him to?
Karvonin.
RHR +(60-80%)(156-RHR)
if the patient had cardiac problems you would use 40-60% of max HR.
Patient is in “revese trendlenberg position”
Postural Drainage: UPPER LOBE
Anterior Apical Segments
LUL
Patient is seated at the end of the bed with UE supported on tray table. and LE flat on the ground.
Postural Drainage: UPPER LOBE
Posterior Apical Segments
LUL and RUL
Patient is supine pillow supporting neck with LE supported on a bluster or foot of bed raised slightly.
Postural Drainage: UPPER LOBE
Anterior Segments
LUL and RUL
Head of bed raised to 45 degree angle. Turn from prone. Rest on RIGHT side. Head and shoulders raise, supported on pillow
Postural Drainage:
UPPER LOBE
Posterior Segments
LUL
Turn from prone, rest patient on left side and support with pillows. LE slightly elevated
Postural Drainage: UPPER LOBE
Posterior Segments
RUL
A therapist Tips foot of bed about 12 degrees. Turn patient from supine and rest on right side to support with pillows. What lobe are they trying to drain?
Lingular Segment (LUL)
A therapist tips foot of bed raised about 12 degrees. Turn from supine, rest on left side, support with pillows. What lobe are they trying to drain?
RML (Lingular segments)
PT places patient in supine with a pillow supporting the head and pillow under the knees. The bed is tipped 18-20 degrees. Which lobe is being drained.
LOWER LOBE
Basal Segments
ANTERIOR LLL and RLL
PT places patient in prone and tips bed 18-20 degrees.Which lobe is he trying to drain?
LOWER LOBE
Basal Segments
Posterior LLL and RLL
PT lies patient on RIGHT side and places a pillow under the patient’s waist to keep the spine straight. Bed tipeed to 18-20 degrees.
LOWER LOBE
LATERAL SEGMENTS
Anterior LLL and RLL
PT lies patient on left side with shoulders not resting on head pillow. Bed is tipped to 18-20 degrees.
LOWER LOBE
LATERAL SEGMENTS
Posterior LLL and RLL
PT places patient in prone with pillow under abdomen to flatten back. which lobe is he trying drain?
LOWER LOBE
Superior Segments LLL and RLL
Based on the following PFT results, interpret the results & classify as normal, restrictive lung defect, or obstructive lung defect (all measured higher than predicted except TV is same)
Obstructive
Which of the following is something that is NOT typically associated with obstructive pulmonary disease?
absent breath sounds
wheezing for COPD
Physical assessment tools that would help confirm the diagnosis of consolidation of a pneumonia include which of the following?
Bronchial sounds heard above lung of consolidation
Define the following ABGs as acidosis/alkalosis, metabolic/respiratory, and then if compensated or uncompensated? pH 7.5, PCO2 45, PO2 74, HCO3 30
Uncompensated metabolic alkalosis
Define the following ABGs as acidosis/alkalosis, metabolic/respiratory, and then if compensated or uncompensated? pH 7.32, PCO2 62, PO2 58, HCO3 30:
Respiratory acidosis, partially compensated, hypoxemia
What would increase fremitus (99 test) in the posterior basal segment be interpreted as?
Increased secretions
A pt is diagnosed with pulm HTN on an ECHO diagnostic report as well as R ventricular hypertrophy. Patient also has a hx of COPD. What is the most probable etiology of pulm HTN and subsequent R vent hypertrophy?
Hypoxemia led to vasoconstriction…
. A PT identifies retained secretions esp in RLL. The optimal intervention to choose for this pt for the retained secretions is which of the following? (No sig med hx):
): Laying on L side, rolled forward, head down, vibration for 3-5 minutes
What breathing exercises would you teach an individual for a CHRONIC lung disease condition to improve gas exchange?
pursed lip breathing
.What breathing exercise would you teach an individual for his current acute lung disease condition to improve gas exchange?
Segmental breathing & maximal inspiration hold
Define 2 contraindications to postural drainage and/or percussion treatments:
HF and TBI
Identify if restrictive or obstructive disease or normal: FEV1 70%, FEV1/FVC 72%:
restrictive (because FEV1/FVC > 70)
Identify if restrictive or obstructive disease or normal: FEV1 56%, FEV1/FVC 90%
restrictive (because FEV1/FVC > 70)
All of the following are advantages of using a CPAP EXCEPT:
decreased risk of sinus infection
. All of the following are advantages of non-invasive compared to invasive ventilation EXCEPT
decreased anatomic dead space
Which of the following are common side effects of albuterol (B2 agonist)?
all of the above- supraventric arrhythmia, nervousness and restlessness, and increase myocardial work
Which of the following is the best diagnostic procedure to evaluate for CF?
lab sweat test
Based on the ventilator mode settings, which of the following patient is showing the most likely progression as they are being weaned off the ventilator?
Control–>AC–>assist
Your 54-y/o male admitted with respiratory failure who has been on the ventilator since admission 2 days ago is ready for early mobility and after your initial eval you set functional goals that are realistic. Patient was (I) in all activities prior to admission. Which would be the MOST realistic functional goal?
Independent in airway clearance within 2 days as evidenced by sputum production
A PT is going to treat a pt with COPD. Which of the following questions would be most beneficial to ask to determine if this patient is more affected by emphysema or chronic bronchitis?
Do they cough up secretions?
